Strapping the hemiplegic shoulder prevents development of pain during rehabilitation: a randomized controlled trial

Objective: To determine whether strapping ( therapeutic or placebo) the 'at risk' shoulder prevented or delayed development of hemiplegic shoulder pain better than standard care. Design: Randomized controlled trial. Setting: Three inpatient rehabilitation hospitals, Melbourne, Australia. Patients: Thirty-three patients 'at risk' of developing hemiplegic shoulder pain were randomized, one withdrew. Patients at risk were considered to be those with low or no muscle function around the shoulder ( Motor Assessment Scale, upper arm score <3). Interventions: Standard care for control group. Therapeutic strapping or placebo strapping with lightweight adhesive tape. All strapping was maintained over four weeks. Main outcome measures: The primary outcome was number of pain-free days measured on Ritchie Articular Index. Secondary outcome measures included range of movement, function ( Motor Assessment Scale, upper arm component) and affected arm muscle tone ( Modified Ashworth Scale). Results: Only one patient in the therapeutic strapping group developed pain. One-way ANOVA revealed that mean number of pain-free days over the 28-day period was significantly different ( P = 0.02), with the difference between the therapeutic strapping and the control group. Patients in the therapeutic strapping group had a mean of 26.2 pain-free days, while those in the placebo group and control group had a mean of 19.1 and 15.9 pain-free days respectively. Range of movement and function improved between admission and discharge but were not significantly different between groups. Conclusions: Therapeutic strapping limited development of hemiplegic shoulder pain during rehabilitation in at risk stroke patients. Placebo strapping has an effect, with a larger study ( n = 30 per group) needed to detect whether there are differences between therapeutic and placebo strapping.